No time to CARE – where is the Compassion, Attention, Response to need, and Efficacy?
In Mavis’s recent blog she referred to maternity services rather than maternity care when she argued that we are losing the caring element of traditional midwifery practice as we hastily process women through the system. This is equally true in mainstream health services. Here are two accounts to illustrate why there is an imperative to bring back and campaign for CARE in our health service and why this general election could be key.
I know an elderly independent couple both in their eighties, (I’ll use pseudonyms for them). Miriam, has debilitating emphysema: she can barely walk more than a few steps without becoming breathless. Nevertheless, she is stoical and sharp-witted and loves our outings in the car to find yet another establishment selling tea and good cake. Her husband Tom this year needed an urgent hernia repair, for which they had to drive forty miles to a centre where surgeons carry out hernia repairs. Patients are sent home the same day.
Miriam had to drive as Tom was in too much discomfort to drive himself. He was also reliant on Miriam for his transport home. There was no question of an overnight stay. So, this elderly couple had to find their way to a surgical centre in a locality entirely unfamiliar to them. After the procedure was performed, Miriam had to drive her husband home, in the dark, along unlit, tortuously winding Lincolnshire roads. Miriam talked of the fear she felt when she took a wrong turn and neither of them knew where they were.
Nevertheless, they arrived home safely and Tom recovered from his surgery: no thanks to anyone caring about how they accessed services, how they might safely return home and no account taken of their age or Miriam’s disability. In other words, they had no CARE. No care was taken to plan the most appropriate, convenient and easy-to-access, care for this couple. Whatever happened to Government rhetoric of more care in the community and care closer to home? This is the reality, as private outfits tender and win the contracts to carry our routine low risk, high profit surgical procedures. Caring takes time, and time is money, so care is eliminated in the name of efficiency and cost effectiveness.
This second account is on-going and very recent. My friend’s daughter had a nasty horse-riding accident. Despite wearing a safety back brace, her fall resulted in, not one, but four fractured vertebral spinous processes, and a haematoma - that she was not informed of- and which displaced her kidney. She was transported by blue light ambulance to the nearest trauma unit. She was assessed and the diagnosis of her injuries made, though no mention of a haematoma was shared with Sally.
At 23.45, that same day, she was discharged and transported home, over an hour’s drive, in her husband’s car. In terrific pain she, and her husband were quite literally left to get on with it, dosed up as she was, with a supply of very strong pain-relieving drugs. Sally was told there is no treatment for fractured spinous processes, they will re grow in time and they will take time to heal. However, a simple google search suggests there ought to be more support than she has been offered. Sally was offered no follow up, no rehabilitation, no back brace, but instead advised to see her GP as required. No physiotherapy was planned, quite literally nothing. No care. Sally found out about her haematoma from a senior colleague who was able to view her scan pictures and who was taken aback that she did not already know about it.
Sally was sent home in excruciating pain, she had the potential of urinary retention, due to the pressure of the haematoma. She had the potential of on-going bleeding and collapse. At the very least safety would have been enhanced by overnight observations, and close attention would have made Sally feel safer and more cared for. The opposite was her reality. Thankfully, she did not go into urinary retention, and whether the haematoma is resolving, is anyone’s guess. No mention of a simple haemoglobin check, or re-scan has been planned. Meanwhile Sally is at home and is struggling to walk, struggling to get in and out of a chair and is barely capable of the very basics of self-care, yet alone care of her family, school runs and her own work.
Sally’s mother, my friend, in her mid-seventies, has been drafted in to take over the family duties, and take on the caring role. She looked exhausted, not just with household work and walking the dogs, but also worrying for her daughter; as well as the strain of ensuring her daughter receives the right medication at the right times as prescribed by the hospital, with no professional help, advice or support over what has turned out to be a long and very painful weekend.
Is this what we mean by ‘care in the community’? That mothers, siblings or even children take over care, the care we had come to expect from our National Health Service? THIS is the fallout from closure of hospitals and reduced availability of hospital beds and professional health workers to provide CARE. Care in the community is virtually non-existent, an ideal penned into policy documents, to mask the reality of covert openings for privatisation and cost reductions resulting in loss of CARE, placing the responsibility of CARE squarely back to families and in the main, let’s face it, women.
Stories like these detailing the failing of an underfunded and understaffed NHS have served to prepare us, the public, for fundamental changes in a service which, though starved of resources, has been and still is the best value for money in the world, (see the Commonwealth Survey 2017.)
In the run-up to the general election the future of the NHS is in all of our minds and is one of the most crucial issues and is the site of argument and misinformation. Although 26% of services in England are already privatised, according to Allyson Pollock, the government is arguing that privatisation will halt and even be reversed. It has dismissed claims that the NHS is ‘up for grabs’; that a post-Brexit deal with the US would ‘betray our NHS’ and that the price of drugs would rise so that 500 million pounds of NHS money would be sent to the US every week. While we cannot know for sure what will actually happen after a general election and if Brexit goes ahead, it is reasonable to assume that the UK will move towards a US insurance-based model. The US government has been clear that it wants greater access to the NHS and other public services. The official wish-list for US-UK trade negotiations, published in February, stated clearly that it would be looking for ‘non-discriminatory treatment with respect to the purchasing and sale of goods and services’ in the UK’s ‘state-owned and controlled enterprises (SOEs)'; the US pharmaceutical industry body wants ‘full market access for US products’, including ’competitive market derived pricing’ and the quoted figure of £500 million a week is taken from the words of Andrew Hill, a drug pricing expert in Channel 4’s Despatches who said that the NHS could end up paying £27 billion more for drugs each year in a post Brexit us trade deal. (The Guardian 11/11/2019).
Mavis asked if a campaign to bring back CARE could be orchestrated to out Governments with toxic, underhand policies which are quite literally putting people’s lives at risk. The first step might be to reinforce and retain an NHS which is not only free at the point of delivery but in which providers are not influenced by a profit motive. Count me in.
DH (2003) Delivering the Best - Midwives contribution to the NHS Plan. (Department of Health). http://www.midwifery2020.org.
DH (2010a) Equity and excellence: Liberating the NHS. (Department of Health). http://www.tsoshop.co.uk